Thousands have knees replaced needlessly

Study shows thousands of full joint replacements are carried out where simpler surgery could be better

Up to 50,000 patients undergoing full knee replacements each year could benefit from simpler surgery, according to a study. Analysis by Oxford University found partial replacements should be performed on nearly half of those who have full-joint surgery. Nearly 100,000 knee replacements were carried out in 2016, but fewer than one in 10 patients had a partial replacement, a procedure where only the affected part of the knee joint is replaced.

UP TO 50,000 patients undergoing full knee replacements each year could benefit more from simpler surgery, according to a new study.

Analysis by Oxford University found partial replacements, which are safer and easier to recover from, should be performed on nearly half of those who having full-joint surgery.

Nearly 100,000 knee replacements were carried out in 2016, but fewer than one in 10 patients had a partial replacement, a procedure where only the affected part of the knee joint is replaced. The procedure is less invasive, allows for a faster recovery, carries less post-operative risk and provides better function. It is also a cheaper intervention for the NHS, in both the short and long term, they said.

The study analysed data from the National Joint Registry (NJR), where they found that partial replacements were better for patients who have only part of their knee affected by arthritis and could therefore have either a partial or a total replacement.

According to the NJR, of the 98,147 knee replacements undertaken in 2016, only 9 per cent were partial, also known as unicompartmental replacements. The research, published in the journal BMJ Open, compared people who had a partial knee replacement with those who had a total knee replacement, but could have had a partial replacement.

They found the use of partial replacement varies greatly between different surgeons. Partial replacements carried out by surgeons using them for a small proportion of knee replacements provide worse outcomes than total replacements. But partial replacements carried out by surgeons using them for a high proportion of knee replacements provide better outcomes and are cheaper for the NHS than total replacements, they said.

Prof David Murray, one of the colead researchers, said: “This is an important finding. If surgeons aim to use partial knees in a quarter or more of their knee replacements, this will substantially improve the results of knee replacement and will save money.

“In addition, more partial knee replacements will be done and more patients will benefit from this procedure.”

The team, from the university’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), said that, while partial knee replacements can be better and cheaper for patients over 60, the long-term benefits for those under 60 are less clear, compared with those of total knee replacements.

“The main strength of this study is that we were able to use real data, from very large numbers of people, about their actual operations, their GP visit, and their own reported quality of life outcomes in a way that is not always possible,” said Dr Rafael Pinedo-villanueva, one of the co-lead researchers and a senior health economist at NDORMS. “This has allowed us to provide strong proof that partial knee replacements are both better for patients and cheaper for the NHS.”

Previous investigations have found as many as one in seven hospital procedures are unnecessary owing to a trend of over-treatment in the NHS.

The health service has attempted to tackle the problem since Sir Bruce Keogh, its former medical director, attacked “profligate” ordering of unnecessary treatments costing up to £1.8billion a year, enough to pay the wages of all ambulance staff for three years. He attributed the problem to low thresholds for interventions, a preference for expensive treatments despite cheaper alternatives being available, and a misdiagnosis of illnesses.

Since then, however, local health chiefs have been increasingly forced to “ration” knee replacements in an effort to cut their costs.